Today’s Electronic Health Record (EHR) systems provide new levels of transparency and accountability for operations and performance that are often far more advanced than legacy systems. One function receiving more attention with more modern EHR software systems is charge capture and revenue accountability. Traditional models would call for providers to solely focus on providing patient care, leaving the back-end business office to ensure charges for care provided are correctly captured and recognized. Billing and coding from paper charts, billing forms, and dictation records have long been the norm.
Current EHR systems provide real-time charge capture at the point of care driven by orders, notes, and actual charge selection by the clinician during the documentation process. Providers and department managers now have instantaneous information regarding revenue from their patients, which is shifting charge management expectations from the business office to the point of care. Department heads and clinic managers that were previously expected only to manage patient throughput are now asked to explain changes in revenue volumes and ensure the accuracy of charges for services provided. Charge capture accountability is the process of engaging operations in charge reconciliation to ensure the accuracy and comprehensiveness of charging. A strong charge capture accountability process prevents erroneous charging, missing charges on performed services, and increases the overall financial integrity of the organization.
For some organizations, this shift in accountability is minor as they already have had similar practices and tools in place. For others, however, this can be significant, distressing, and disruptive. Many organizations will establish a group of representatives from the various cost centers and clinics to be “charge champions” upon implementation of the new EHR system. These individuals are provided with the system tool and training so they can be held accountable for monitoring revenue and financial performance for their respective areas. Here are some tips on establishing a successful program for charge capture and revenue accountability.
START WITH A PLAN: The program starts with a structured plan. When developing a charge champion program, you need a business plan that clearly identifies the program, participants, ownership, accountability, and long term plans beyond system implementation.
ESTABLISH OWNERSHIP: Establish ownership of the charge champion program. If your organization does not already have a Revenue Integrity department or lead, it is important to establish one. When creating messaging around this program, you will want to ensure you state that it is not about shifting the responsibility for monitoring and reporting revenue to the clinicians, but rather asking the care providers to use the tools provided to report on what they’ve been doing all along – just in a new way.
PROGRAM SUPPORT: The program must be supported from the top down. Enlisting the support and ownership of the charge champion program must include all C-levels and have at least one sponsor who is publicly onboard and acknowledges that they are ultimately responsible for revenue. Ideally, this is the COO, CNO, CEO, or similar administrator and not the CFO. It is also important to enlist the help of senior leaders to help kick-off meetings with charge champions, participate in discussions, and encourage member involvement.
START EARLY: Do not wait until just before system implementation to unveil the charge champion program. Hold the kick-off meeting at least six months in advance of go-live and meet monthly to discuss what is coming. Meetings should include demonstrations of the actual system tools and reports the members will be using to monitor and report on their revenue. Be honest and open about what the actual expectations of the participants will be and hold a mock meeting to show members what the revenue review meetings will be like throughout go-live.
IDENTIFY CHARGE CHAMPIONS BY NAME While it might make the most sense to identify the current owners of the cost centers, clinics, and department heads as charge champions, they may not be the best advocates or willing participants. Identify at least one person from each cost center and clinic to be a part of the team and encourage them that this is something they want to be a part of. Break your team up into various revenue areas such as Inpatient departments, Therapies, Primary Care clinics, Specialty clinics, etc. When you have the right people participating, meetings throughout the go-live process will be more focused and effective.
STICK TO THE PLAN: Holding charge champions accountable for learning, using, and reporting on revenue using the new tools ay be painful for some, and you may get push back. Guide them as needed with “what to do” sessions and individual meetings. Encourage them that what they are doing is positive and will result in improvements for the organization and their respective areas.
REPORT OFTEN: Report often and meet monthly once the program is established. After the go-live when revenue is stable, meetings are scaled back, and charge champions are breathing a little easier, it is important to continue holding them accountable for monitoring their areas of responsibility. Ensure that they continue receiving and reviewing the reports and using the tools that are inherent within the new EHR system. Similarly, hold one charge champion meeting each month going to review high-level successes and address any new or lingering issues or areas where revenue has shifted from expected levels.
Much of the success of your charge champion program will be driven by the culture and system tools. But if the right people are called upon to participate, senior leadership is supportive, and expectations are clear. There should be no reason to expect anything less than complete success with your implementation, stabilization of revenue, and ongoing review and monitoring. If you are interested in learning more about how Optimum Healthcare IT can assist you with programs like this, please click here.
